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目的探讨新乡地区1997年至2009年儿童和成人肺炎克雷伯菌的耐药性变迁并进行对比分析。方法采用全自动微生物鉴定系统和纸片扩散法(K-B)法对13年间临床分离的肺炎克雷伯菌成人1993株和儿童297株,用28种抗菌药物进行药敏试验。结果儿童和成人组肺炎克雷伯菌对美罗培南、亚胺培南、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦均高度敏感。高度耐药的抗菌药物为氨苄西林。大部分抗菌药物成人组的耐药率大于儿童组,尤其哌拉西林、哌拉西林/他唑巴坦、氨苄西林、氨苄西林/舒巴坦、庆大霉素、奈替米星、环丙沙星、诺氟沙星和氯霉素等,差异均有统计学意义(P<0.05)。大部分抗菌药物的耐药率13年间有普遍增高趋势,且大多具有显著差异。近3年来,一些抗菌药物耐药率稍有降低。产超广谱β-内酰胺酶(ESBLs)率分别为儿童组33.3%,成人组37.0%。结论针对儿童和成人肺炎克雷伯菌的耐药率及变迁的区别,对于成人的耐药率不适用于儿童,各地区应分别定期监测成人和儿童的耐药结果以供临床参考。
Objective To investigate the change of drug resistance of Klebsiella pneumoniae in children and adults from 1997 to 2009 in Xinxiang area and to make a comparative analysis. Methods Thirty-eight antimicrobial agents were tested for susceptibility to Klebsiella pneumoniae in 1993 and 297 children, respectively, using a fully automated microbial identification system and disk diffusion method (K-B). Results Klebsiella pneumoniae was highly sensitive to meropenem, imipenem, piperacillin / tazobactam and cefoperazone / sulbactam in children and adults. Highly resistant antimicrobials are ampicillin. Most of the antimicrobial drug-resistant adult group than in children, especially piperacillin, piperacillin / tazobactam, ampicillin, ampicillin / sulbactam, gentamicin, netilmicin, cyclopropyl (P <0.05). The difference was statistically significant (P <0.05). Most antibacterial drug resistance rates generally increased during the 13-year trend, and most have significant differences. In the past three years, some antimicrobial resistance rates slightly decreased. Produced ESBLs rates were 33.3% in children and 37.0% in adults, respectively. Conclusion The resistance rates and changes of Klebsiella pneumoniae in children and adults are different from those in adults. The drug resistance rates in adults are not suitable for children. The drug resistance results of adults and children should be regularly monitored in all regions for clinical reference.